Social assistance programs are used in many countries to provide food or cash to combat maternal undernutrition with the goal of improving health of children by reducing low birth weight and neonatal mortality.  The effectiveness of programs has been evaluated in some locations using experimental or quasi-experimental methods.  However, to date, a critical review of those observations has been lacking.  Leroy and colleagues performed an analysis, and they report the results of their review in a paper published in the December 2021 issue of The Journal of Nutrition.

A search of the literature resulted in the identification of a limited number of studies meeting the inclusion criteria.  Cash transfer studies were conducted in Mexico, Colombia, India, and Uruguay and the one community-based participatory learning and action program was conducted in Nepal.  The Grading of Recommendations, Assessment, Development and Evaluations system was used to evaluate certainty of the evidence supporting an impact on birth weight and neonatal mortality.

Only 4 studies included birth weight as an outcome, and a significant increase was observed in them all.  Neonatal mortality was monitored in 3 of the included studies, and 2 noted a significant reduction for those participating in the assistance program.  The certainty that the assistance program improved the incidence of low birth weight or neonatal mortality was rated as being very low because of methodological limitations.  The authors concluded that more work needs to be done in the future using better designs that determine the mechanisms contributing to the impacts, such as maternal diet, antenatal care seeking, skilled delivery use, and women’s empowerment.  They furthermore recommended that the potential negative consequences (reduced birth spacing and excess pregnancy weight gain) of social assistance programs should also be monitored.

In an editorial, Popkin provides an overview of the studies included in the review by Leroy and colleagues, and describes their differences, which contributed to the inability to reach certainty.  As a result, Popkin points out that it is not possible to generalize on the outcomes of the interventions, but concludes the the work by Leroy and colleagues suggests there are positive effects of these assistance programs on pregnancy outcomes.


Jef L Leroy, Bastien Koch, Shalini Roy, Daniel Gilligan, Marie Ruel, Social Assistance Programs and Birth Outcomes: A Systematic Review and Assessment of Nutrition and Health Pathways, The Journal of Nutrition, Volume 151, Issue 12, December 2021, Pages 3841–3855,

Barry M Popkin, Cash Transfer Programs are Important for Improved Nutrition in Low- and Middle-Income Countries, The Journal of Nutrition, Volume 151, Issue 12, December 2021, Pages 3599–3601,

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